The Digital Revolution

Law, governance, diversity, social equity and ethics will be the real challenges

The digital revolution or as it is now commonly referred to as the “fourth revolution”, is by all accounts a revolution. The technology train has left the station and if you didn’t know, we are all on board, like it or not.

From devices, we have moved to digitisation. Devices are simple, cheap pieces of junk that create value when they are used, mainly because they create, collect and interpret data. Research is no longer small and randomised, its big, where n = 10 million or a billion or even a trillion. The Internet of things is now the internet of everything.

Driving won’t be driving it will be just known as transport as autonomous vehicles will become the norm in the next decade. No need for licenses. Don’t have to own a car, ever.

Who will own the cars, well, who cares, unless you’re Ford, Chrysler, Audi, BMW or Toyota. If you are disabled, old or inebriated, you can still get to where ever you’re going! Just hit the app and a car will arrive.

With over 55,000 road deaths per annum across the OECD, the prediction is that driverless cars will dramatically reduce road deaths. No more accidents due to texting, fatigue or alcohol. It is predicted that my grandchildren will never hold a licence or own a car.

Of interest is that in the US, where there are over 35,000 road deaths per annum, driverless cars are likely be adopted very quickly. However, a legal opinion expressed in a letter from the US National Highway Traffic Safety Administration to Google confirmed that the artificial intelligence software it uses to control its self-driving cars could effectively be viewed as the “driver” for someregulatory purposes.

It was widely viewed that Google’s AI software, the self-driving system, is very likely to be regarded as being legally the same as a human driver. So, if the AI is recognized in some cases as the driver, how will compliance to road safety legislation be managed? Who will develop the AI driver test and what should that test look like?

Lowered road accidents, greater independence; no need to spend money on cars or their upkeep, because we won’t actually own a car anymore. There is a downside though, futurists are predicting that there will be over 1million truck drivers who will lose their jobs in the US alone. Where does a truckie go to find work if transport is autonomous?

But let me tell you what I think a car is becoming

I see a world of increasing workers-at-home and decreasing business centralization.

Longer-distance driving to work and longer commutes; one in which security and safety is a valuable additive. A world in which we are increasingly reluctant to be out-of-touch or not working for any serious period of time.

The car is going to become a workplace, communications centre, an entertainment centre, a shopping centre.

The Age of the Intelligent Car is just beginning.

Around the world, the taxi business is worried about Uber but the real enemies of their business model are a search engine, a space rocket company and a Swedish automotive company; google, tesla and Volvo. These companies are quickly advancing driverless car technology…. uber itself is in the mix with their version of an autonomous vehicle and it may survive if its risk appetite is high and its hubris is low.

This 4th revolution means that businesses can expand and grow exponentially because their strategies are constructed under models that are scalable and repeatable, globally. Scaling and repeating doesn’t cost much money and it often requires very few people to make it happen.

Shopping, which was once a physical therapy is no longer simple retail because buying and consuming is not linked to a strictly physical experience anymore.

If we look at the Australian super market trade; a long-term duopoly, we have always been referred to as the country where on a worldwide comparison, you can get the fastest national distribution of a product. Why? because there have always been only two large providers who are national. Get on their shelves and you are literally everywhere, instantly.

But now their tidy world is about to blow up. Amazon is coming and with a supermarket emphasis and a highly refined but virtually driven business model the predictions are that it will literally change the way we buy our groceries and likely have a major effect on our two giants, Coles and Woolworths.

A simple, scalable model, based on the theory consolidation and distribution via the internet. Don’t believe that people won’t buy things like food off the net, they are and they will continue to do so. Food hero, uber eats, menu log; fact is, we are very happy to buy food off a picture on a website and eat it.

Will Amazon employ tens of thousands of people to run this new supermarket? No, people are not part of the fourth revolution; employing lots of people is a thing of the past.

As for stores, they won’t look like a super market you’re used to seeing. There will be one or two buildings, located in an area far away from where you live. Tech enabled it will have very few people on site. All pick and pack done by bots and the shipping will be done by driverless trucks. Their balance sheet won’t include investing in property or infrastructure but rather it will be about investing in artificial intelligence and big data.

Sourcing and supplying products in ways that will have a lower cost base, less people costs, no infrastructure to speak of. And its strategic relationships? Well indirectly, that’s going to be with you. Yes you, the individual.

In fact, they are already your very best friend. They know more about you than your mother. They know almost everything they need to know about you now. Where you live, what your disposable income is, how and what you spend it on, the style and size of your house, what your health status is, your age and sex, marital status, do you buy chocolate, use the internet, how many devices you have, what sites you go to most regularly, where you holiday, what you like to eat, what you buy from the super market now.

Remember, every single device you own, your phone, TV, lap top iPad and so on is easily and often hacked. I mean easily! The off button may not actually mean the device is off. Have you heard of the “fake off” button? It’s especially prevalent in smart TVs. Your smart phone and devices like your laptop; well they are working while you are sleeping but just not for you.

They can listen, record and film while turned off.

And now let’s move to my favourite, healthcare. The fourth revolution holds promise when it comes to affordability and equity whilst simultaneously finding ways to cannibalise and monetise your data.

The digitisation of almost everything is causing a revolt amongst healthcare stakeholders. Clinicians and physicians fear their role will be replaced by bots and algorithms.

Regulators are scratching their heads to find ways to qualify outcomes and claims because the validity of the old ways is weakening every day as new paradigms surface and are adopted as mainstream.

Providers of digital solutions in the form of bots, apps, medical devices, algorithms and therapeutics are subject to excessive yet often unproductive scrutiny. This delays their adoption and blocks the building of the data set and the ultimate integration of data and devices.

Fear not, we have witnessed other revolutions; the industrial revolution which affected so many sectors like manufacturing and supply chain, created a major disruption and a new world order.

So, when it comes to healthcare be prepared because this particular revolution is tantamount to the deconstruction of medicine as we know it.

Thanks to movements like Quantified Self, the Human Genome Project, and other health hacking organisations, the patient and their personal profile are starting to determine decisions.

No cookie cutting here. The cry out from mainstream is: “I am as unique as my DNA” …. So, don’t try clustering me into the group of 200 patients who formed the research cohort that secured the FDA approval in 1963. I either want big data to justify the protocol or I want it to be about me and just me.

And not forgetting that trusty GP, Doctor Google; medicine is now patient directed rather than doctor directed. In fact, Google is now an official advisor to the CMS tracking things like flu outbreaks. It informs where the outbreak is happening, how many people are getting ill and informs the CMS as to the mostly likely type of flu, based on searches done by the public, which in turn informs the local emergency departments and drug suppliers to get ready.

The digitisation of everything to do with health is about real time collection and interpretation of information. Principally, it’s about the precision, accuracy and the accountability of data.

Personalised, digitised and democratised.

Bed less hospitals, mobile virtual treatment, bots taking the place of surgeons, radiologists, oncologists and every other specialist you can name. Greater accuracy with diagnostics and big data making decisions which were once made by the doctor at the bedside. A single decision maker versus a billion decision makers.

I’m a bit worried here; so, who do I sue if the diagnosis is wrong?

To this extent, Artificial Intelligence is the cornerstone of this revolution. It isn’t yet an entity in its own right (one whom you can sue) but it is becoming as respected as the health professional. Artificial Intelligence is becoming the doctor of choice because it able to coalesce the data that is being collected from a million of human tests and apply the decision-making protocols of thousands of medically trained brains to analyse across data sets of such magnitude, it eradicates the need for individualisation by comparing and contrasting the individual against a huge and continually growing data set.

So, will AI and specific algorithms be able to get medical negligence insurance?

Your chest x ray or the MRI on your brain will be interpreted based on millions of other x rays and MRIs. So, the opinion expressed as to diagnosis and therapy is not just that of your doctor and his or hers limited experience but that of the tens of thousands of doctors and their patient records collected over decades integrated into one diagnostic tool.

So, there we have it; big data is the collective intelligence generated by billions of brains and growing. Its counter intuitive to the notion of individualised medicine but somehow, personalised medicine does fit into this world.

What then is the future of “intuition”? That very human gift of experiential learning. Well, the algorithms are trained to able to measure and compare, analyse and determine the diagnosis. Its methods may appear to be limited to objective data but I promise you, it is learning so much so quickly that predictive intuition will start to appear. Just keep feeding in massive data and the algorithm will learn.

Think about the commercially bought wearable and there are dozens of these devices being worn by millions of people.

The Fitbit is collecting millions of data points across the globe about fitness and movement. But remember, it also knows where you are, where you live, your social media status, your sleep patterns, weight and height and with a very simple stretch of data analysis, your risk of diabetes or cardiac disease. It might hold more valuable and powerful healthcare data than a government. So, will corporations hold more information about you than the government or your insurer?

Mobile, body worn healthcare devices are the fastest growing sector of wearables. They will outstrip all other wearables by 2019, just 2 years from now. The question is, what happens to all the so called big data they collect?

There is little research that proves that wearing a Fitbit will make much difference to your health outcomes and it’s hard to understand why millions are still being sold however there is some good news. The Fitbit was recently used to disqualify a marathon runner who cheated. The organisers secretly hacked his fitness device he was wearing and were able to prove that he took a short cut to the finish!

Irrespective of their health benefit efficacy, Fitbits are sold in millions for one reason: Data. The future sales of these devices may wane but they are monetising the data every day.

All this data collection and interpretation creates a new risk for society; Cyber security.

Domestic, criminal, international; the black-market risk of data leakage and data theft is a daily reality. Literally 1000s of healthcare environments are hacked daily. It’s costing billions every year and hacking in healthcare is growing at 200% in the US and Australia is listed as #2 in world for Healthcare data security break ins/theft, second only to the US.

Australian healthcare companies are being held to ransom by hackers and that ransom is being paid. I literally mean ransom money is being paid to cyber criminals to give the data back safely.

Control of the information is not just about security. We can’t guarantee we actually know who has the right to the data. Who owns the data.

For example, the benefits of electronic medical records are obvious and there is hardly a western government that is not investing in the implementation of opt in EMRs. Its opt in now but by the time our children (or my grandchildren) are adults, it will be compulsory for insurance reasons.

One final anecdote for us to think about. Will the revolution bring about a real change when it comes to matters of diversity? For the first time, we are evidencing clinical trials that are differentiating between men and women. Traditionally this has not been the case but with big data, it is now possible and the findings are really powerful. Who knew, women are different to men!

But generally, though there are some small gains happening I would say that when we know that there are hardly any women appointed to our front bench of parliament, less than 25% of public company boards are female, and women are still paid significantly less than men. Having been one of the less than 4% of female’s CEOs of a public company, I can assure you it is lonely at the top. There’s hardly anyone who isn’t pale, stale and male.

What is starting to generate interest is the fact that there is validated evidence that companies with a more diverse board are more profitable. Profit. This will always attract interest!

But diversity comes in so many different manifestations. It’s not just gender related. Older people have a massive amount of experience and wisdom and younger people if well directed could have a lot to contribute to boards. I know from experience, a board with mixed ethnicity, abled and disabled and gender diverse will always drive better outcomes.

Challenging the notion of the pale stale male is multifaceted and progress is slow. So, you can imagine how excited I was when I heard that a company had diversified by appointing analgorithm to its board of directors. Women everywhere battle to get a crack at this position and now an algorithm has got there. What an interesting but unbiased board member!

This particular company focuses on drugs for age-related diseases and the board is forced to make various decisions and recommendations by sifting through large amounts of data.

Apparently, the board has welcomed the algorithm, which formally attends each board meeting providing specific reports. It looks at a range of data including financial information, clinical trialsintellectual property owned by the firm and previous funding.

In this case the algorithm retains formal voting rights, approving of investments and influencing the other board members. This is an interesting expression of Artificial Intelligence personhood.

So, is the algorithm aware of its fiduciary rights or the corporations act? I would think not. It makes no sense at all to think that the algorithm will actually be responsible for the decisions made by the board but make no mistake, the rest of the board will be called to account if their decisions prove to be wrong or negligent and blaming the algorithm isn’t likely to be a defense, or is it?

It is unbelievable but here we have it; as women and other marginalized members of society continue to fight to gain positions of influence and authority, we find ourselves facing yet another foe that we will never be able to match; Artificial intelligence.

Should we be happy and excited about the future? Absolutely we should. But be prepared to be challenged and disrupted as old values disappear, being replaced with new processes and paradigms. A more inclusive society? No, just one that is more connected and democratized.